Provider Demographics
NPI:1689846271
Name:WADDELL, PATRICIA ANNETTE (FNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNETTE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 E BROADWAY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4948
Mailing Address - Country:US
Mailing Address - Phone:865-475-9062
Mailing Address - Fax:865-475-9063
Practice Address - Street 1:657 E BROADWAY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4948
Practice Address - Country:US
Practice Address - Phone:865-475-9062
Practice Address - Fax:423-475-9063
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341753Medicaid
TN10350I2070Medicare PIN
3341753Medicare PIN
TN3341753Medicaid
3716673Medicare PIN